NCI Cancer Bulletin: A Trusted Source for Cancer Research NewsNCI Cancer Bulletin: A Trusted Source for Cancer Research News
May 25, 2004 • Volume 1 / Number 21 E-Mail This Document  |  Download PDF  |  Bulletin Archive/Search  |  Subscribe

The information and links on this page are no longer being updated and are provided for reference purposes only.

Insurance Coverage for Breast Cancer Screening
and Related Services

All 50 states and the District of Columbia (collectively, states) have enacted laws addressing private health insurance coverage for breast cancer screening and/or breast cancer-related services. The bar chart below illustrates the number of states with laws addressing private health insurance coverage for: (1) screening mammography; (2) postmastectomy services (i.e., reconstructive surgery, prosthetic devices, and therapy for lymphedema); and (3) inpatient care following a mastectomy, lymph node dissection, or lumpectomy.

Screening Mammography

  • All states except Utah have enacted legislation addressing mammography coverage.
  • Forty-six states require insurers to provide coverage for screening mammography; Arkansas, Michigan, and Mississippi require insurers to offer such coverage.
  • Ohio's law is unique: It requires certain insurers to provide coverage and others to offer coverage.

Postmastectomy Services

  • Thirty-six states have enacted legislation addressing coverage for postmastectomy services.
  • Thirty-four states require insurers to provide coverage for reconstructive surgery after mastectomy, including surgery to establish breast symmetry. Kentucky law mandates that insurers offer such coverage and Michigan law mandates that insurers offer or include such coverage.
  • Twenty-seven states require insurers to provide coverage for prosthetic devices after surgery; in Kentucky, insurers must offer such coverage and in Michigan, insurers must offer or include such coverage.
  • Twenty-seven states require insurers to provide coverage for both reconstruction and prostheses; Kentucky requires insurers to offer coverage for both reconstruction and prostheses; Michigan requires insurers to offer or include such coverage.
  • Insurers in 18 states must provide coverage for lymphedema therapy. Insurers in Kentucky must offer such coverage.
  • Eighteen states require insurers to provide coverage for reconstructive surgery, prostheses, and lymphedema therapy. Kentucky requires insurers to offer such coverage.

Inpatient Care

  • Twenty-one states have enacted legislation requiring insurers to provide inpatient care following a mastectomy.
  • Twelve states require insurers to provide coverage for inpatient care following lymph node dissection.
  • Twelve states require insurers to provide coverage for inpatient care following both mastectomy and lymph node dissection.
  • Three states - Maine, Montana, and New York - require insurers to provide coverage for inpatient care following mastectomy, lymph node dissection, and lumpectomy.

Source: NCI State Cancer Legislative Database Program, April, 2004. http://www.scld-nci.net

Coverage By Private Healthy Insurers